santacruzhealth.com logo

HOME PAGE | SEARCH DIRECTORY | CONTACT HSA

Santa Cruz County Health Services Agency
Health
Benefit Programs


  Contact Information

Already covered by Medi-Cal and need information?

Benefits Call Center
1-888-421-8080

Frequently Asked Questions from the Benefits Call Center

Customer Service Guide

The Health Services Agency no longer facilitates benefit submission for Medi-Cal or Healthy Kids. For information on the MediCruz Specialty Program call:

Health Care Reform Information

News and Announcements

Community Benefit Resources

  • Santa Cruz County Network of Care Web Site - A comprehensive, Internet-based resource guide for the elderly, people with disabilities, people in need of Behavioral Health services, as well as their caregivers and service providers.

  • Santa Cruz County Human Services Department

  • Health Insurance Counseling & Advocacy Program (HICAP) - provides free, confidential, unbiased Medicare counseling for the community. Call 831-462-5510 or 831-637-0630.

  • VA Health Portal - Healthcare and benefit information for veterans.

  • Did you know there is a program that provides discounted prescription medicines? The Medicine Program
    * Please note "The Medicine Program"  is not affiliated with the County of Santa Cruz Health Services Agency and is provided here for informational purposes only. 


(Back to the Benefits Index)

--- Access for Infants & Mothers (AIM) ---


What services are offered?

  • Prenatal visits and hospital delivery.

  • Full health care services during pregnancy and 60 days after.

  • Full health care services for the baby born from the AIM-covered pregnancy (for the first 2 years).

Who can be covered?

  • Pregnant women (not more than 30 weeks pregnant at time of application).

  • Baby born from the AIM-covered pregnancy (birth to 2 years old).

  • Persons who are receiving no-cost Medi-Cal benefits are NOT eligible.

Is there income limit?

Verified income must be between 200% and 300% of the Federal Poverty Level (FPL).

 

Is there a property limit? 

No.

 

Can services be received if there is other health insurance?  

Yes, but only if the insurance does not cover maternity care or if there is a separate maternity deductible or co-payment over $500.

 

How much does it cost?

2% of gross family income (current or previous year’s) which can be paid over 12 months, and $100 for the child’s second year of coverage (or $50 with an up-to-date immunization record).

 

Is citizenship or legal residency required?

No, but applicant must have resided in California for six continuous months at time of application.

 

Where to apply?

Call (800) 300-1031 for an application, assistance and information. California State Managed Risk Medical Insurance Board


 


(Back to the Benefits Index)

 

 

--- Cancer Early Detection Program Every Woman Counts ---

The Cancer Detection Programs: Every Woman Counts (CDP:EWC) provides free clinical breast exams, mammograms, pelvic exams and Pap tests to California’s underserved women. 

Breast Cancer Screening Information

Do you qualify for free services? You may if you:

  • are 50 years old or older
  • have low income*
  • have medical insurance that does not cover breast cancer screening
  • have a high insurance deductible or co-payment
  • are not getting these services through Medi-Cal or another government-sponsored program
  • live in California
  • July 14, 2010 update regarding the CDP:EWC Fiscal Year 2010-11 budget, which is under discussion in the Legislature: CDP:EWC is continuing no new enrollments until it is determined how much money will be appropriated to pay for breast cancer screening services in Fiscal Year 2010-11.  CDP:EWC has put on hold the biennial mammograms cost savings policy changes that were proposed to be in effect July 1, 2010 pending adoption of the Budget Act of 2010.  

    Cervical Cancer Prevention Information

    Do you qualify for free services? You may if you:

  • are 25 years old or older
  • have low income*
  • have medical insurance that does not cover cervical cancer prevention screening
  • have a high insurance deductible or co-payment
  • are not getting these services through Medi-Cal or another government-sponsored program
  • live in California
  • CDP:EWC is continuing to enroll for cervical cancer screenings.

    *2009-2010 CDP: EWC Income Criteria (PDF, New Window)

    Call 1-800-511-2300 Monday - Friday from 8:30 AM to 5 PM.

    We speak English, Spanish, Mandarin, Cantonese, Korean and Vietnamese. If you qualify, you will be referred to participating doctors in your neighborhood.

    If you don't qualify, the CDP:EWC representative for your area may know of other low-cost screening programs that might be available to you.  The Regional Contractors are also your link to support groups, advocacy groups and the latest information on what's happening in your community.

    Treatment Information

    If you are diagnosed with breast or cervical cancer:

    Free treatment is available to all Californians who qualify through the Breast and Cervical Cancer Treatment Program.  Information on this program is available on MediCal's website or call 1-800-824-0088 to speak with an eligibility specialist.

     


    (Back to the Benefits Index)

     

    --- California Children Services (CCS) Program ---

     

    What services are offered?

    • Diagnosis and treatment of CCS eligible conditions by CCS approved physicians and at CCS approved hospitals, Special Case Centers (SCC) and Medical Therapy Program (MTP).

    • Provides medically necessary care and case management to infants, children, and adolescents meeting program eligibility requirements. These include physician services, hospitalization, occupational therapy, in-home nursing services, and supplies.

    Who can be covered?

    Children under 21 years of age who have medical and disabling conditions that meet CCS eligibility criteria.

     

    Is there an income limit?

    Family income less than $40,000 (Annual, Adjusted Gross Income on State Tax Form) – OR – if out-of-pocket medical expenses for the qualified child are expected to be more than 20% of the families annual income. Services provided at a Medical-Therapy Unit (MTU) are exempt from financial eligibility requirements.

     

    Is there a property limit?

    No.

     

    Can services be received if there is other health insurance?

    Yes. (CCS only covers diagnosis and treatment of a child’s CCS eligible condition).

     

    How much does it cost?

    There may be an assessment and / or enrollment fee depending on income.

     

    Is citizenship or legal residency required?

    No. Must be a permanent resident of Santa Cruz County. If not a Santa Cruz County resident, may apply in County of residence.

     

    How to apply?

    Call Santa Cruz: (831) 454-2540 OR Watsonville: (831) 763-8900



    (Back to the Benefits Index)

     

    --- California Kids ---

     

    What services are offered?

    Benefits include medical, dental, vision, prescription drugs, behavioral health and 24-hour nurse access.

     

    Who can be covered?

    • Residents of Monterey County ONLY!

    • Be age 2 through 18 and not married;

    • Not eligible for coverage under Medi-Cal or Healthy Families;

    • Not enrolled under any private health care plan with coverage for preventative care;

    • If school age, be enrolled and attending school;

    • Each child in a family must be enrolled and the family’s income must meet specific guidelines.

    Is there an income limit?

    200% Federal Poverty Level.

     

    Is there a property limit?

    No.

     

    Can services be received if there is other health insurance?

    No.

     

    How much does it cost?

    $25 application fee, no monthly premiums required and minimal co-payments of $5 for each service and a $25 co-payment for emergency care.

    Is citizenship or legal residency required?

    No.

     

    Where to apply?

    Salud Para La Gente, 204 E. Beach St. Watsonville. Phone: (831) 728-0222

     

     


    (Back to the Benefits Index)

     

    --- California Major Risk Medical Insurance Program (MRMIP) ---

     

    What services are offered?

    Comprehensive health insurance for those who are unable to obtain coverage on the open market.

     

    Who can be covered?

    You cannot be eligible for both Part A and Part B of Medicare, unless eligible solely because of end-stage renal disease. (Being eligible for one part or the other is acceptable).

     

    Medi-Cal beneficiaries are not prohibited from enrolling, but should carefully consider the cost of the MRMIP monthly subscriber contributions.

     

    You must be unable to secure adequate coverage demonstrated by:

    • Having been denied individual coverage within the previous 12 months.

    • Having been involuntarily terminated for health insurance coverage within the previous 12 months for reasons other than nonpayment of premium or fraud.

    • If you have been offered, in the previous 12 months, an individual, not a group, health insurance premium in excess of the Major Risk Medical Insurance Program subscriber rate for your first-choice participating health plan.

    • If you are a member of a group of two or fewer (not including dependents) who has been denied health insurance coverage in the previous 12 months.

    Is there an income limit?

    No.

     

    Is there a property limit?

    No.

     

    Can services be received if there is other health insurance?

    You cannot be eligible to purchase any health insurance for continuation of benefits under COBRA.

     

    How much does it cost?

    Varies according to individual health plan choice, age, and County of residence.

     

    Is citizenship or legal residency required?

    Must be California resident.

     

    Where to apply?

    Call: (800) 289-6574

    Visit: www.mrmib.ca.gov/MRMIB/MRMIP.html

     

     


    (Back to the Benefits Index)

     

    --- Child Health & Disability Prevention Program (CHDP) ---

     

     

     

     

    What services are offered?

    • Regular complete health checkups and shots. (Based on age, entitled to 15 or more exams).

    • Temporary Medi-Cal coverage up to 60 days for qualifying children.

    What does a family need to bring to a CHDP visit to confirm eligibility?
    Families with Medi-Cal insurance must bring their insurance cards. Families that have no insurance must complete and sign a form declaring their income at the visit.

    Where can a child receive a CHDP examination?
    Most pediatricians and many family practitioners are certified CHDP providers. Often physicians or clinics have nurse practitioners or physician assistants who are CHDP Examiners. Often, families can go to their child’s usual health care provider. Call your doctor’s office to find out if the office participates in the CHDP Program. If your doctor is not certified, click on County CHDP Providers to learn the locations of certified providers.

    Who is eligible for a CHDP examination?

    • All children and youth birth through 20 years of age who are certified as eligible to receive Medi-Cal.

    • All children and youth birth through 18 years who do not have Medi-Cal but do meet the family income eligible levels described below.

    • Any child attending a Head Start or State Preschool Program who meets income edibility.

    Is there an income limit?

    Up to 200% of the FPL (see Income Eligibility Determination Table)

     

    Is there a property limit?

    No.

     

    Can CHDP services be received if there is other health Insurance?

    Yes, if insurance plan does not cover Well-Child exam or immunizations.

     

    How much does it cost?

    No Cost.

     

    Is citizenship or legal residency required?

    No.

     

    How to obtain services?

    Schedule an appointment with a CHDP doctor. Call CHDP for a list of current doctors.

     

    Where to call for more information or names of CHDP approved doctors?

    Santa Cruz: (831) 454-2560 OR Watsonville: (831) 763-8932

     

    Click here to visit the CHDP Web Page

     


    (Back to the Benefits Index)

     

    --- Family Planning, Access, Care, And Treatment (FAMPACT) ---

     

    What services are offered?

    • Comprehensive family planning services including contraceptive services.

    • Pregnancy testing, female and male sterilization, limited infertility services.

    • Reproductive health counseling and education related to contraceptive methods.

    • Counseling and education related to contraceptive methods, screening for sexually transmitted infections, as well as breast and cervical cancer.

    Who can be covered?

    Women and men who are California residents.

     

    Is there an income limit?

    Up to 200% of the Federal Poverty Level (FPL).

     

    Is there a property limit?

    No.

     

    Can services be received if there is other health insurance?

    Yes, in the following instances:

    • if they have Medi-Cal with an un met share of cost on date of service;

    • if benefits do not cover family planning services;

    • if the insurance requires a deductible that has not been met;

    • f the client's use of their other coverage would create a barrier to access because of confidentiality.

    How much does it cost?

    No cost to patient.

     

    Is citizenship or legal residency required?

    Must be a California resident, but no citizenship requirement.

     

    Where to apply?

    At participating clinics and physician offices. Call 1 (800) 942-1054 for a listing.

     

     


    (Back to the Benefits Index)

     

    --- Genetically Handicapped Persons Program (GHPP) ---

     

    The Genetically Handicapped Persons Program (GHPP) arranges and pays for medical care and rehabilitation, when authorized, for some adults and children who have inherited conditions and who are unable to pay for all or parts of their care. Some of the conditions are Cystic Fibrosis, PKU, Hemophilia, Sickle Cell Disease, and inherited diseases that may appear later in life. There is no income limit, but there may be an enrollment fee. GHPP has only one office in Sacramento to serve the entire state. 

     

    For more information, call GHPP at (800) 639-0597

     


    (Back to the Benefits Index)

     

    --- Health Insurance Premium Payment (CARE/HIPP) ---

     

    What services are offered?

    Pays health insurance premiums for family and individual policies

    For HIV positive persons for up to 12 months.

     

    Who can be covered?

    Must be disabled and unable to work full-time because of HIV/AIDS.

     

    Is there an income limit?

    Up to 250% of the Federal Poverty Level.

     

    Is there a property limit?

    Assets cannot amount to more than $4,000 (excluding one house and one car).

     

    Can services be received if there is other health insurance?

    CARE/HIPP supports participants to maintain their health insurance Coverage as they transition into Medi-Cal.

     

    How much does it cost?

    Co-payments and deductibles are not paid.

     

    Is citizenship or legal residency required?

    Must be a permanent resident of California.

     

    How to apply?

    Call The CARe Team at (831) 454-4730 or Santa Cruz AIDS Project: (831) 427-3900 or 1(800) 367-2437 



    (Back to the Benefits Index)

     

    --- PAC Advantage ---

     

    What services are offered?

    Comprehensive benefits are offered by each health plan. Subscribers make health plan choices based on cost, doctor/hospital network, level of co-payment, type of plan, and services offered by each. Additional dental plans are available.

     

    Who can be covered?

    Employees working for small employers with 2-50 full time employees may enroll. There are no restrictions based on the type of business operated, the health of the employee group or the age of employees.

     

    Is there an income limit? 

    No.

     

    Is there a property limit? 

    No.

     

    Can services be received if there is other health insurance? 

    No.

     

    How much does it cost?

    Employers should call their Independent Agent for a quote or call 1 (877) 735-5742. Rates change once a year.

     

    Is citizenship or legal residency required?

    Employer standards apply.

     

    Where to apply? 

    Call 1 (877) 735-5742.

     


    (Back to the Benefits Index)

     

    --- Medicare ---

    Medicare "Help is Here" Prescription Rx Resource Kit

     

     

     

     

    What services are offered?

    • Part A (Hospitalization).

    • Part B (Outpatient).

    Who can be covered?

    Persons eligible to receive Social Security or Railroad Retirement benefits due to age (65 years or older), disability or blindness who have received Social Security for at least 24 consecutive months, chronic renal disease.

     

    Is there an income limit?

    No.

     

    Is there a property limit?

    No.

     

    Can services be received if there is other health insurance?

    Yes.

     

    How much does it cost?

    • Premium for Part B ($45.50 in 2000).

    • Deductibles and co-payments.

    (State will pay premium if beneficiary also receives Medi-Cal).

     

    Is citizenship or legal residency required?

    Yes.

     

    Is there a web site to learn about Medicare?

    Yes. www.medicare.gov or www.kff.org

     

    Where to apply?

    Social Security Administration

    Call toll free 1-800-772-1234 or

    169 Walnut Ave., Santa Cruz

    (831) 426-8111

    -OR-

    315 Main Street, Watsonville

    (831) 722-7141

     

     


    (Back to the Benefits Index)

     

     

    --- Medicare Reimbursement Programs ---

     

    What services are offered?

    The government pays part of all of your Medicare premium based on your income.

     

    Who can be covered?

    Medicare beneficiaries entitled to receive Part A Medicare.

     

    Is there an income limit?

    Up to 175% of the Federal Poverty Level (FPL).

     

    Is there a property limit?

    Yes, depending on family size:

     

    1 Person $4000 2 Persons $6000

     

    Can services be received if there is other health insurance?

    Yes.

     

    How much does it cost?

    Nothing.

     

    Is citizenship or legal residency required?

    Yes.

     

    Where to apply?

    Call toll free for an application: 1-(800)-952-8627.

     

      


    (Back to the Benefits Index)

     

    --- MediCruz ---

     

    What is the MediCruz program?

    MediCruz is a County of Santa Cruz managed health care program of last resort for the uninsured residents of Santa Cruz County. If you have private health insurance or are eligible for any other public health benefit program such as Medi-Cal (including PRUCOL) or Medicare you will be required to apply for them instead of MediCruz.

     

    What services are offered?

    MediCruz provides financial assistance for medical care for qualifying medical conditions, with limited pharmacy services based on the MediCruz formulary (no generic drugs available), laboratory services, and x-ray services. 
    Click here for services that are not covered by MediCruz.
    Services are covered for a limited period specific to the treatment of the qualifying condition. Clients are expected to renew their application every two to three months depending on medical condition. 

    What are the requirements for MediCruz eligibility?

    • Must be a current permanent resident of Santa Cruz County and provide proof of residency. 

    • Must be between the ages of 19-64 years old. 

    • Must have a current medical need that is covered by the program. These are subject to medical review. 
      Click here for
      list of medical conditions that are not covered by MediCruz.

    • Income cannot exceed 100% of the Federal Poverty Level guideline. An applicant with a monthly income over 100% Federal Poverty Limit ($931 for one person) is ineligible for MediCruz.

    • If you have private health insurance, Medicare or Medi-Cal you are not eligible for MediCruz

    • If you have a work-related injury you must file for worker’s compensation. 

    • If you have an injury from an auto accident you must file a claim against your auto insurance and the other car owner’s insurance if appropriate. 

    • Income tax returns, pay stubs, and bank account statements are required. 

    • Eligibility workers will require verification of various information during the eligibility interview.

    Are there MediCruz co-pays or share of cost?
    MediCruz clients are required to pay:

    • $12 co-pay for office visits

    • $4 co-pay per prescription

    • $45 Emergency Department visit co-pay

    • $15 retinal eye scan co-pay, and others as approved by the Board of Supervisors.

    MediCruz clients might also have to pay a share-of-cost based on their income.

    What is the difference between MediCruz and Medi-Cal?

    Medi-Cal is a statewide program to provide health coverage to people eligible for welfare benefits (have minor children in the home with an absent or incapacitated parent). It also is for people who are pregnant, under 21 or over 65, blind or disabled. MediCruz is a local program to assist low-income individuals not eligible for Medi-Cal.

    Are there citizenship or residency requirements?
    A non-citizen applicant who does not have permanent residency status can apply for MediCruz for primary care services ONLY (no emergency care). Regardless of citizenship/residency status, all applicants must be permanent Santa Cruz County residents

    Where do I apply for MediCruz?
    You can for apply for MediCruz at either of the two County health care clinics. Eligibility workers are available on a first come first serve basis. Click here for list of what verification documents you must bring in to apply. 

      Santa Cruz Health Center

      1080 Emeline Ave. Room 101

      Santa Cruz, CA  95060


      Eligibility Hours:

      Monday thru Friday

      8:00 - 12:00 PM

      1 - 5 PM

       

      Tel. (831) 454-4070

      Watsonville Health Center

      9 Crestview Dr.

      Watsonville, CA 95076


      Eligibility Hours:

      Monday thru Friday

      8:00 - 12:00 PM

      1 - 5 PM

       

      Tel. (831) 763-8033

    Did you know there are many programs that provide prescription medicine for free?
    The Medicine Program
    * Please note "The Medicine Program"  is not affiliated with the County of Santa Cruz Health Services Agency and is provided here for informational purposes only. 

    (Back to the Benefits Index)

     


      The Great Seal of the County of Santa Cruz.

       Mailing Address: County of Santa Cruz  Health Services Agency
       1080 Emeline Avenue, Santa Cruz, CA 95060 | Phone: 831 454 4000 | Fax: 831 454 4770
       Hearing Impaired TDD: 831 454 2123 | copyright© 2000 County of Santa Cruz

     
    County of Santa Cruz Home Site - Disclaimer - Site Index - Contact Us - Feedback